As state and federal governments start to implement various provisions of the new health care reform law, family physicians need to stay engaged and involved in the process. That was one of the major themes to emerge from the 2010 Family Medicine Congressional Conference held here May 11-12 and attended by more than 160 family physicians.

AAFP Board Chair Ted Epperly, M.D., says the AAFP will use its advocacy efforts to "hardwire" the tenets of family medicine into the DNA of the nation's health care system.

"This is not the end of our journey," said AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, who spoke on strategies for the future. "It is only the beginning."

The two-day conference reflected that theme. Session topics echoed the framework of the new health care reform law and included sessions on physician payment, the future of the primary care physician workforce, innovative programs in the new law, and lobbying 101. The conference culminated in visits to Capitol Hill offices on May 12 as AAFP members carried the message of the importance of family medicine to lawmakers and their staff members.

AAFP members made three major requests to their elected representatives in terms of Medicare payment reform:

replace the sustainable growth rate, or SGR, formula with a more equitable payment system;

increase the eligibility requirements for the 10 percent Medicare primary care bonus in the new health care reform law; and

retain the CMS final fee schedule rule for 2010, which has led to a payment increase for primary care services.

In his address to conference attendees, Epperly reiterated the message that the federal government has moved from the "legislative to the regulatory phase." He vowed that the AAFP will continue to be actively involved with the implementation of health care reform and will advocate to "hardwire" the tenets of family medicine into the DNA of the nation's health care system.

"We are going to be all over this as regulations get drafted, when regulations get published with comments and when Congress has oversight hearings on these activities," Epperly said. "We are going to make sure there are outstanding family physicians present on all the boards and commissions. We are going to have our people at every conceivable place to make sure that what we have started is done."

Primary Care Bonus

The AAFP also will continue to push Congress for improvements in the existing health care reform legislation, according to Epperly. For example, the legislation contains a 10 percent Medicare payment bonus for the next five years for primary care practices that provide at least 60 percent of their services in primary care. The AAFP, however, wants that bonus threshold reduced to 50 percent of primary care services so that more primary care physicians qualify. In addition, said Epperly, the bonus itself needs to be increased. A 10 percent bonus is only a "starting point," he said.

The AAFP's support for health care reform is based on its long-standing commitment to health care for all and its unshakeable belief that primary care, family medicine and the patient-centered medical home have to be at the center of delivering care, according to Epperly.

"I am here to tell you that America cannot be cared for by 1 million anesthesiologists and dermatologists," he said, sparking applause from the audience. "They just don't have the comprehensive approach."

In the past few years, the AAFP has taken advocacy to new levels, becoming a bold champion of family medicine in the process and earning a seat at highest levels of the health care reform debate, according to Epperly.

"We recognized that if we didn't step up, that other people would, and their message wasn't ours," he said.

Epperly urged conference attendees to work with their patients, medical colleagues, AAFP chapters and state and federal officials to "help them understand what it is that we are trying to accomplish."

AAFP's Pivotal Role

Kavita Patel, M.D., director of the health policy program for the New America Foundation in Washington, echoed Epperly when she noted that the "job for physicians and other providers has just started."

A former director of policy for the Obama White House's Office of Intergovernmental Affairs and Public Engagement, Patel described family physicians as pillars of their communities and individuals who can validate the true benefits of health care. "You serve as the doctors for our country," said Patel, a board-certified internist.

Patel, who had a major role in drafting the federal health care reform law, described the measure as "largely a health insurance and health access bill with a lot of very important innovations." She also explained the rationale behind health care reform, unveiling a pyramid-shaped model that showed the various building blocks of health care reform.

Payment for value serves as the apex of the pyramid, followed by components such as incentives for coordination of care; improved measurement and reporting; investments in a high quality, community-based workforce; and private insurance market regulations. Enhanced primary care access is the foundation of Patel's pyramid.

"The ultimate outcome is care of our patients," she said. "All of these things (in the pyramid) are really tools in the tool box to get us there."

Like other speakers, Patel addressed primary care physician workforce issues, saying, for example, that, "none of us in the White House thought for a moment we could do (health care reform) without a significant investment in the workforce."

She also decried the income disparities between primary care physicians and subspecialists, citing a study that shows medical students forfeit about $3 million during the course of their careers by choosing primary care instead of a subspecialty.